MEDICARE: FAMILY INITIATIVE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1578203642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY INITIATIVE

Provider Business Mailing Address
First Line	:	734 SW 4TH ST UNIT 6
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-1922
Country	:	US
Telephone Number	:	239-910-0712
Fax Number	:

Provider Business Practice Location Address
First Line	:	734 SW 4TH ST UNIT 6
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-1922
Country	:	US
Telephone Number	:	239-910-0712
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED BEHAVIOR TECHNICIAN
Name	:	CARTER THADDEUS DUMAS
Credential	:
Telephone Number	:	518-651-4408

Provider Enumeration Date	:	03/29/2022
Last Update Date	:	03/29/2022

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Directions to “FAMILY INITIATIVE ” Practice Location

Language	Start Address	Practice Location

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